Saturday, November 13, 2010

Some Thoughts on Working the Community Pharmacy Part 2

Drive thru in pharmacy can be the biggest help and the biggest pain all in one package. The idea is that you don't have to get out of your car, walk inside the building, go to the back of the store, get your prescriptions, and walk back. This is especially helpful for those who have difficulty walking, have a very contagious disease, or have another condition that would make getting into the store a difficult task. The biggest trouble with drive thru is that many people equate faster service to instant service. The time saver has more to do with the aspect of parking the car, going into the store and so on. Drive thru doesn't mean that the prescription bag will be ready and waiting in hand the moment you drive up or even soon thereafter. The same issues one could face coming in the pharmacy building are ones that will be dealt with at the pharmacy drive thru.

Insurance will always be a constant. Insurance changes with job changes, yearly enrollment, life changes, and other more minor events. It will always have to be updated. These issues can crop up without warning and often do, which is why it is impossible for anyone to predict when they come in or go through drive thru that their issue may take some time to resolve. Thus, it doesn't make sense to say that people who have insurance issues should come inside, because you can't exactly plan for this. Neither is it fair for those who have insurance issues to come inside. They have their reasons for going through drive thru and theirs, like everyone else's, should be respected.

Sometimes the pharmacist needs to go over the medication with the patient. At times that can be in great detail and take a great deal of time. Drive thru doesn't mean poor patient education nor does it mean that the patient already knows about their medication. They have the right to the same treatment in drive thru as they do if they come inside.

With that understanding, there are a few things that people must understand when they go through drive thru.

*Medication is an important part of improving and maintaining good health. However, all medication comes with risks and those risks are lessened with good patient education about the medication. As such, please refrain from using a cell phone, blasting loud music, or being too distracted by the passengers in the car to actually listen to the pharmacist. Not only is it rude, but it can also be potentially dangerous.

*If you don't want your health information shared with everyone in the car, either come inside where you can have a one on one with the pharmacist or come alone to pick up your medication. We try to keep the speaker sound down enough that only the car next to the speaker can listen in on the conversation, but we can't just limit it to the driver's seat- there's no way to keep the rest of the car from listening in to the conversation.

*Be patient. As previously mentioned, faster doesn't mean instant. The medication has to be located, rang up on the register, and the pharmacist must counsel, that's the law. Refill, new ones, doesn't matter. Patience is key in making the experience pleasant and as easy as possible.

Thursday, November 11, 2010

Some Thoughts on Working the Community Pharmacy

I love my job. I do. I wouldn't trade it for the world. I get to help people feel better and be the liaison between them and their insurance company to make sure they get the medications they need when they need it. I am the eyes and ears for the pharmacist whilst checking them out at the register to make sure that I note and mention to the pharmacist any OTC purchases that might interfere with the Rx meds the patient just picked up.

However, just like any job, there are frustrations. A pharmacy is not a fast food joint slopping medications together and putting them in bottles as if each one was the same. Even the "simplest" medications to fill have checks and balances that last (at minimum) fifteen minutes. What would that be? How hard can it be? Let me try to explain simply a process that is anything but simple.

0-7 minutes: Locate patient in database. Make sure information on script about patient matches the patient located in database. Scan in hard copy of the script into the computer under the patient's name. Type script into the form on the computer (check with pharmacist when in doubt of handwriting!!) Submit to insurance company. If insurance company rejects, research why- refill too soon, submission code clarification, needs a diagnosis code, insurance is expired, medication needs a prior authorization in order to be covered, insurance will only cover so many pills in a given time, insurance doesn't cover the medication at all, or any number of random odds and ends that aren't so common. Issues can double on multiple insurances. Send to pharmacist once insurance issue has been resolved, if any.

7-12 minutes: Pharmacist reviews typed work. Checks to make sure all fields are entered in correctly matching it up against the hard copy. Pharmacist checks medication against patient's known allergies, other medications that could cause an interaction, as well as any health conditions that may cause a problem with the medication. Once this is complete, the medication leaflet is printed and the filling process can begin.

12-14 minutes: Medication leaflet is printed and the filling technician locates the medication on the pharmacy shelves and counts out the medication. It can be "easy" with 30 or less, but a technician can see quantities of 200 or more. Specially controlled medications require the pills to be counted twice. Medication is placed in a tote with the leaflet and sent to the pharmacist.

14-15 minutes: Pharmacist verifies that the medication chosen is correct through visual inspection of the medication. Notes are placed in the computer or even on the leaflet if the pharmacist wants to double check information with the patient before dispensing the medication.

Fifteen minutes later, if there are no hiccups or special circumstances, the medication is ready to be sold to the patient. It's amazing, really, that the process doesn't take more time.

Wednesday, August 18, 2010

Researching Death

As part of my continuing education to keep my PTCB certification, I did a packet of CE's on stem cell research. Granted, this was an "older" packet, dating back to 2008, but the issues raised in my mind are still very relevant today. The basic questions are still asked, "When does life really begin?", "Can we justify killing one person to save another?", and the like, but this time while reading the packet, more came to mind than just that.

Although stem cell research has become the hot button issue in the medical and pharmaceutical industries as of late, I think it starts before that. I think it starts where they say they get their supply. In Vitro Fertilization clinics (IVFC) are where the supply of frozen embryos come from that they then extract and research the stem cells. I think the ethics might start even before that, but for my purposes, that is where I will start. I am still not quite sure why a frozen person is allowed to sit in a freezer for months or even years at a time and the claim is that they are not needed. I know I wouldn't be particularly fond of it if someone put me away until they needed me quite like that.

Then there is the question of why the embryonic stem cells. Unless one wants to make some sort of a political statement, it occurs to me that perhaps the best course of action when something is this controversial is to refrain from using what is controversial. Adult stem cells have shown promise and at the very least might unlock secrets important to the research into stem cells. At the best, it could provide the very fulfillment of the promise that embryonic stem cells seem to hold. The point is, why not try the path of least resistance first? Why not research the adult cells to the furthest they can be and then analyze that? Not that I am saying that the end result would be the death of more innocent children at the hands of "science", but it seems like the possibility has been dismissed because the embryonic stem cells show more promise. Even if that is true, at what cost?

Then there is the even bigger questions that surround this debate. By what standards are ethics judged? Who gets to decide how morals are judged? Why is it okay to question religion and not science? That's one that particularly gets me. Science has been proven wrong- the world isn't flat and you can't fall off the end of it. The earth is not the center of the universe and all the other heavenly bodies don't orbit around it. Science should be weighed equal to religion in this: there needs to be the realization that science can be wrong- science has failed humankind. During the 1918 flu epidemic, a leading scientist theorized that the flu was caused by a bacterial agent and not a virus, and began treating patients with antibiotic medication. The treatment was obviously not effective and a significant portion of the world population was depleted.

If the claim can be used that religion merely misleads people into thinking or believing a fairy tale, the claim should also rightly be used that science has done the same. Yes, science is still growing, and still learning and progressing, however, the theories we are sure are correct today may be laughed at in a few centuries as easily as we dismiss the idea that the earth is flat today. This debate should not have the scales tipped to the side of science because it can be proven. If it was all proven, they wouldn't call it "theory" or "hypothesis" and those words are definitely not synonyms for "fact".

Monday, August 9, 2010

Frustrations and Triumphs

Well, about a month ago, Walgreens laid me off as a PhT. I can't help but be frustrated at it. They have done great to take care of me, though. They got me a job at less pay at the front end so that I could still make ends meet and have worked hard to keep me up to date on when call backs are happening, which is great because I truly miss being in the pharmacy. The good news related to that is that I took my CPhT test three days after they laid me off and got a 867 out of 900, with passing being a 650. Now I can sign my name with a CPhT at the end if I wanted to! :) I am a nerd, I'll admit it.

I am still waiting for my dh to get a full time call so that he can get on with his career and we can move on from this drawn out chapter of him working at Walmart. Don't get me wrong, they have been good to him, too, but it's definitely not what he wants to do with his life. I am hoping that with the election of Pr. Matt Harrison to the LCMS presidency that he can work to help those who have unfairly been removed from their calls as pastors and can work to put them back into the Synod by bringing light to this injustice and reassuring congregations that these are good men in bad circumstances who deserve a "second chance" as a full time pastor. By God's grace, our feelings of exile will soon come to an end.

Friday, June 25, 2010

A Little Heartache...

I miss my family. Every day I think about them and I hope that they are okay. I wish I could see them and be with them every day. However, that is not where God has us. They are scattered among many different states and there are miles between us, but that doesn't keep them far from my heart. My folks are coming to see me in a few days. I haven't seen them in a year. It will be good to talk and laugh and tell stories and enjoy the bonds that God gave us many years ago. I am hoping to see my older brother, his wife and kids in a few weeks. I haven't seen them in a couple of years, which is way too long for me. The kids have gotten so big, I am sure. My little brother and his wife are expecting. I haven't seen them since their wedding, and really then I didn't get to spend that much time with them. I was merely a support character in the background of their big day. In fact, I was so involved taking care of my niece and nephew that I am not sure I ever made it into any of the pictures! I just hope they know how much I love them and how special they are to me. Family is a wonderful gift from God.

Friday, April 30, 2010

Do They Add Up?

I have been looking over the numbers that I was able to glean from the CSL and CTS websites regarding placement. (There is a key to the abbreviations at the bottom of the page.)

CSL placement list
CTS placement list

Here's what I found:
  • CSL M.Div and A.R. candidates placed: 88
  • CTS M.Div and A.R. candidates placed: 40
  • CSL M.Div and A.R. candidates awaiting placement: 4
  • CTS M.Div and A.R. candidates awaiting placement: 21
  • CSL CCMC, CHS, DELTO, and EIIT candidates placed: 28
  • CSL CCMC, CHS, DELTO, and EIIT candidates awaiting placement: 5
So the numbers are actually a bit different than first indicated. CCMC, CHS, DELTO, and EIIT are all special programs that receive special placements. They aren't considered a part of the general pool of candidates in the same way as M.Div and A.R. candidates. So the disparity between the two is actually 21-4. The 4 candidates from St. Louis make up approximately 4.35% of the eligible placement class of 92. The 21 candidates from Fort Wayne make up approximately 34.43% of the eligible placement class of 61.

Furthermore, I also analyzed the number of candidates from each seminary placed into each district. The first number represents the CSL M.Div and A.R. candidates. The second number represents the CTS M.Div and A.R. candidates.
  • Atlantic: 1-0
  • California-Nevada-Hawaii: 3-0
  • Central Illinois: 3-1
  • Eastern: 0-1
  • English: 2-1
  • Florida-Georgia: 2-1
  • Indiana: 0-4
  • Iowa East: 0-2
  • Iowa West: 4-3
  • Kansas: 2-2
  • Michigan: 5-6
  • Mid-South: 1-0
  • Minnesota North: 4-1
  • Minnesota South: 5-0
  • Missouri: 5-1
  • Montana: 2-0
  • Nebraska: 5-1
  • New England: 1-0
  • New Jersey: 0-0
  • North Dakota: 0-2
  • North Wisconsin: 3-2
  • Northern Illinois: 4-1
  • Northwest: 7-0
  • Ohio: 3-1
  • Oklahoma: 0-1
  • Pacific Southwest: 4-0
  • Rocky Mountain: 1-1
  • SELC: 1-0
  • South Dakota: 3-2
  • South Wisconsin: 5-0
  • Southeastern: 4-0
  • Southern: 1-1
  • Southern Illinois: 2-1
  • Texas: 5-3
  • Wyoming: 0-1
The following districts received CTS M.Div and/or A.R. candidates but did not receive any CSL M.Div or A.R. candidates. These districts received a total of 11 CTS candidates. The number of CTS candidates received per district is in parentheses:
  1. Eastern (1)
  2. Indiana (4)
  3. Iowa East (2)
  4. North Dakota (2)
  5. Oklahoma (1)
  6. Wyoming (1)
The following districts received CSL M.Div and/or A.R. candidates but did not receive any CTS M.Div or A.R. candidates. These districts received a total of 34 CSL candidates. The number of CSL candidates received per district is in parentheses:
  1. Atlantic (1)
  2. California-Nevada-Hawaii (3)
  3. Mid-South (1)
  4. Minnesota South (5)
  5. Montana (2)
  6. New England (1)
  7. Northwest (7)
  8. Pacific Southwest (4)
  9. SELC (1)
  10. South Wisconsin (5)
  11. Southeastern (4)
The following district did not receive any M.Div or A.R. candidates from either seminary:
  1. New Jersey
The following districts did not receive any CSL M.Div or A.R. candidates, but did receive CSL CCMC, CHS, DELTO, and/or EIIT candidates. The number of candidates received per district is in parentheses:
  1. Eastern (2)
  2. New Jersey (1)
M.Div = Master of Divinity
A.R. = Alternate Route
CCMC = Cross Cultural Ministry Center
CHS = Center for Hispanic Studies
CSL = Concordia St. Louis
CTS = Concordia Theological Seminary (Fort Wayne)
DELTO = Distance Education Leading To Ordination
EIIT = Ethnic Immigrant Institute of Theology

Thursday, March 4, 2010

Why do we do the things we do?

Traditions and rituals are passed down from generation to generation for a reason. Often these are honored and revered but just as often they are objects of ridicule because it appears that those who follow them are unwilling or unable to change. Those who want to try to recreate the Christmas of their childhood are looked upon with understanding and love as they try to recapture their youth while those who participate in a church using the same liturgy passed down from the centuries are seen as old fashioned and stubborn. Why is that?

Why is it that the liturgy is such an important part of being a Confessional Lutheran? Well, you can leave it to the pastors to tell you the reasons why it is formed the way that it is. You can hear how it is rooted in the Scriptures, that it follows a pattern leading up to Communion, and that it is set in a way that teaches us about God's goodness every step of the way. But that isn't all. There is more that is very basic and simple.

Liturgy is Scriptures put to song. When you are teaching young children, you sing to them to help them learn. This includes the ABCs, learning the days of the week, and many other things. The same is true of the liturgy. Singing the same thing every week helps memorize and put to heart those things which we need to know. Anyone who has tried to sit down and memorize the Bible will find it a insurmountable task. However, we know more Scriptures than we think just by singing them every Sunday. To change that, to eliminate that, would be to take away a great teaching tool from the people of God. Others might think that it is boring and mundane, but then again, they need to learn what is going on. Passed down from the generations, rekindled at the Reformation, and brought to the Americas from the German language, the liturgy in the form that it is has taught God's people about God's grace and mercy four countless generations. These same Scriptures put to song in the liturgy come to mind in some of the roughest situations to remind us of God's grace and mercy. Humming tunes through the day (especially when they get stuck in our heads) helps bring the remembrance of the Scriptures in our daily lives.

The next time someone wonders aloud why I am so unwilling to change, I think I might just remind them what a treasure trove we have with the liturgy and why it is too good to give up for something that doesn't compare.

Sunday, February 21, 2010

Something Old, Something New (for me!)

So I have been getting my fingers into many different things lately. It is borne from trying my best to work to wean myself off of my stronger medication as well as to find things to do that isn't staring at the TV or computer screen blankly for hours at a time. I have been researching my genealogy and have found ancestors that date back to 1774 in Ireland. I am currently working on learning more about the German side of my family and how the Lutheran line was passed down. I hope I find something about that soon. It has been neat to discover things about my family and link them to historical events that I learned about in school. I think my Irish ancestors were part of the immigration to the Americas because of the Potato Famine. I haven't quite learned the reasons why the German side came to the States, but I am sure I will discover it eventually.

This research helps me feel like I am not so alone. I have all this family, some of which I never knew about, who did things like leave home across the ocean never to return again, and I complain that I am a twelve hour drive away! They managed to forge their way in frontier land and I complain that I have to live in a city where everything is established. It's kinda neat to think about and humbling to realise how much easier I have it than they did, and they survived.

To top it all off, I realize that I take communion with many of these ancestors of mine each Sunday when with angels and archangels and all the company of heaven we partake of the heavenly Feast of the Lamb. That's just awesome- the great grandparents I never met stand with me at the Table. God is just cool like that!

Thursday, January 28, 2010

Necessity is the Mother of Invention

They say necessity is the mother of invention. In my case, they'd be right. Daffy, our little cinnamon pearl cockatiel has been making a nuisance of herself and started plucking her back very badly since winter started. To make matters worse, she royally scabbed up her back and was picking at the scab until it was bleeding horrible. I recognized the need for an e-collar, but was plum out and wondering how I was going to make this happen. Then it dawned on me- I have scraps of material, sew on velcro and a sewing machine. Within ten minutes, I had a reusable, washable, handy dandy e-collar that would bend and allow her to eat without getting in the way and keep her from ripping her back up and ripping off scabs that had formed. I am darn proud of myself! It works like a charm!